Health Committee on Dec. 2nd, 2014

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Thank you.

Mr. Chair, the next question is for Madam Bois.

You stated in your presentation that there are 466 devices. How are they different from each other? Are there 466 types of devices? If there are differences, what are the main differences between them?

[Geneviève Bois]

That's why I say that it's a very heterogeneous kind of category. It's hard to say that there is an electronic cigarette. There are multiple electronic cigarettes. When the WHO report was written, they looked at what was on the market at that moment. They found 466 different devices. They said that an average of 10 a month appear on the market. It doesn't mean that in Canada there are 466, but there is a wide variety. They could be with or without nicotine. There are thousands of flavours. They can be reusable or disposable. The cartridges can be exchanged, or not. Even the way the products look is very different,

This is a ciga-like model. It looks like a cigarette. It kind of has the same shape. It's held the same way. It has a glowing tip, and if you pull on it, it glows. This is a ciga-like model, but there are also e-cigarette models that look like a camera, or a USB key, or any type of other appliance, or like nothing at all that we know, such as an odd square box.

There is a lot of difference both in the way they're used and the way they look, and potentially in what they do to you. That explains some of the contradictions in the data so far. It's because there's no regulation and there are such different models out there. A test performed on one device cannot necessarily be generalized for all the devices on the market; sometimes the test is repeated on the same device and the amount of certain chemicals found is not exactly the same. How hard you puff on the device seems to change the composition of the vapour. The voltage of the battery seems to change the composition of the vapour. Some of the devices are made in a way that you can actually play with some of the settings yourself. That would also change the composition of the vapour. It's a complex product, and it's not one product; it's many different products. It would be like saying all automobiles and trucks and trains are the same because they are methods of transportation.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

We've heard from witnesses at this committee that the nicotine delivery through e-cigarettes is much safer and is better for people who smoke.

Is there any proof that people who don't smoke, young people, when they have a choice, would choose e-cigarettes over regular cigarettes?

[Geneviève Bois]

Unfortunately, in a real-life setting, the only thing you can do is survey young people to see in what percentage they are using cigarillos versus e-cigarettes versus cigarettes versus menthol cigarettes versus none at all.

What we have seen is that there is a very high rate of youth who are trying e-cigarettes. Fortunately, not all of them graduate to regular use. Because the uptake of tobacco products, the more traditional tobacco products, does not seem to have slowed down in Canada in the last couple of years, it does not seem that e-cigarettes are taking the place of traditional tobacco products, at least not in the youth group. It seems that, unfortunately, kids are experimenting both with flavoured cigars and with e-cigarettes. I sure hope that we don't see a gateway effect. We don't have any data in Canada showing that now, which is great news, but they are trying this in increasing numbers.

The fact that the latest data in Quebec shows that 20% of non-smokers in high school, those who have never smoked, have tried an e-cigarette demonstrates an attraction for the product. Whether that means they will eventually graduate to tobacco is not something we can say. I sure hope it is not the case, but the fact that 20% of our high school students who have never smoked a cigarette are trying a product with no benefit to a non-smoker, and we don't know what's in it, and which is available at two for $10 at any corner store, legally, to a 14-year-old, is definitely a cause for concern.

I think you wanted to react to that, right?

[Melodie Tilson]

If I could, I would like to add something quickly. We don't know whether experimentation with e-cigarettes will lead more youth to go on to use cigarettes. We don't know whether it will introduce them to nicotine, which will then lead them to transition to the most effective nicotine delivery device, the cigarette, or whether they'll be more likely to become long-term e-cigarette users. It's still too early, and we don't have very many studies on this correlation at this point.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

Taking into consideration the fact that nicotine is an addictive substance, we can assume that people trying e-cigarettes that contain nicotine will eventually get addicted to it. Would that be a right assumption?

[Melodie Tilson]

We know that e-cigarettes with nicotine are less addictive than cigarettes because they don't deliver nicotine to the brain as quickly as a cigarette does through the smoke, and most devices don't deliver as much nicotine. They are less addictive than cigarettes, but yes, they definitely have addictive potential, which is why we think it's urgent that the government introduce measures to prevent non-smoking youth from getting their hands on these products, to the extent possible.

[The Chair, Conservative, Ben Lobb]

Thank you very much, Mr. Lizon. Your time has come and gone.

Ms. Fry, you're up now.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I want to thank the witnesses for being here today.

I really thought it was very interesting that Dr. Bois said this is being widely used—and I think we should add “wildly”—because there seem to be no parameters set for it, and legislation would obviously give people far more of a definitive way of using it. It might stop young people. Everyone seems to be concerned about the normalization of smoking if young people start using these. If one had the same kind of legislation or the same kinds of regulations as for tobacco, that would deal with some of this issue, and combine it with some sort of public awareness campaign about the use of this, etc. I am beginning to be convinced that this must be the way to go if we're going to stop young people from beginning to use these, etc.

However, the big issue I wanted to ask about is this. We know that the harm reduction tools for tobacco smoking currently in place are the nicotine patch, the medication, and the gum. We see that the patch and the gum don't seem to have as much effectiveness as they could.

The question then is this. What would be the optimum delivery of nicotine that would allow for smoking cessation to actually take place and for people to start cutting down on their cigarettes? That's perhaps looking at regulations that may decide what is the quantity within of the nicotine that's being delivered. That's the first question.

The second question I wanted to ask quickly is this. We've been hearing about the Polish study. Will regulation decrease the risk of that happening here?

I'd like to hear what your answer is.

[Geneviève Bois]

First of all, it's difficult to say. The safest way of consuming nicotine would be, technically, to consume no nicotine. Any product generally carries a risk.

Obviously the cessation methods we have now are far from perfect. The best studies we have on e-cigarettes show that they are on par with nicotine patches. Something we also know, though, is that a cessation attempt within a medical context—where you're followed by a doctor or nurse or both, or in a group that has a program that really looks at objectives with you—doubles and sometimes triples the success rate rather than you at your house, making a plan for yourself and buying whatever device may be available at the pharmacy or the convenience store. Obviously, there are ways of maximizing cessation attempts, and that's definitely something that should be looked into.

Most likely a product will never be completely, perfectly safe, but there are definitely ways of making it safer, or at the very least less risky. That's where regulations really come into effect. If you don't know the battery's going to explode or you don't know how much nicotine there is, that's definitely not the safest way of using it.

As for the exact nicotine content, that needs to be variable. That's what is allowed with patches right now. You have a 21 milligram patch, a 14 milligram patch, and a 7 milligram patch. We often make a plan with our patients to start at the highest and go lower. If it's a heavy smoker sometimes it's two patches at the beginning. It really depends on the smoker and the way it happens. Regulation would definitely make it safer.

As far as Poland versus the U.K. is concerned, I don't think we're British, and we're definitely not Polish, either. What I draw as a conclusion, and many smarter people than I draw as a conclusion, is that there seems to be an effect of where you are in tobacco control and what you do. I think if we play our cards well and continue to work on the tobacco control front very well, and maybe more actively than at the moment, and if we do put in a regulatory framework for e-cigarettes, we can definitely make sure that this acts as a positive thing and not a negative thing. Clearly, if we just leave things to fate and let things happen, it's really not clear it's going to be for the better.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

I just wanted to say that as we look at e-cigarettes containing nicotine, we know that some e-cigarettes or at least the electronic version can contain things other than nicotine. If you regulate e-cigarettes in the same way that you regulate tobacco products and cigarettes, what would you suggest in terms of regulation for ones that do not contain nicotine? How would you regulate those? Would you still put them under the same sorts of regulations as tobacco or e-cigarettes that have nicotine? What would you do with those?

[Geneviève Bois]

We wish for e-cigarettes to be brought under the same regulatory framework, and/or for some specific regulation to be put into place, whether they do contain nicotine or not. Even if this device is said to contain no nicotine, the fact that it looks and acts like a cigarette, is puffed on in the same way, and is inhaled means that it should also be regulated.

I don't know exactly what's in this one, but I certainly know that even if it has glycerol or glycerine or whatever other product we sometimes consume in fast food, a lung is not a stomach. Alveoli in our lungs are certainly made to breathe air and air only, so probably this is not completely risk-free either and should be brought under the same regulatory framework.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Okay, thank you.

Did you want to saying something, Ms. Tilson?

[Melodie Tilson]

Yes.

There's another reason to allow e-cigarettes without nicotine but include them in the same regulatory framework. We hear from smokers who have successfully used e-cigarettes to quit that they often step down the level of nicotine that they use, to the point where they're using an e-cigarette with no nicotine and the e-cigarette is helping them with their continued addiction, hand-to-mouth and other smoking behaviours.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you.

[The Chair, Conservative, Ben Lobb]

Do you have anything else?

[Hedy Fry, Liberal, Vancouver Centre, BC]

No, that's fine.

[The Chair, Conservative, Ben Lobb]

Okay, thank you very much.

We did start our meeting a little late today, so we're going to to give Mr. Young his time.

Go ahead, sir. You have seven minutes.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Thank you all for coming, and thank you for the work that you do to protect Canadians' health and promote the precautionary principle.

As you know, we have serious problems with addictions in Canada, particularly among our youth. That includes tobacco, alcohol, marijuana, street drugs, and even prescription drugs. They rob people of their time, money, concentration, and their dignity.

We've heard a lot about nicotine being harmless.

Madam Bois, you said that 20% of youth in Quebec have tried e-cigarettes. Is that correct? I think it was 18%; we had a figure for the rest of Canada.

[Geneviève Bois]

It's 28% in general in our latest survey, and 20% among non-smokers.

[Terence Young, Conservative, Oakville, ON]

Thank you. It was 20% among non-smokers.

Now, you also said, I think—I want to be really clear on this—that tobacco use hasn't gone down with the introduction of e-cigarettes. Is that correct?

[Geneviève Bois]

If we look at the uptake of tobacco products, both cigarettes and other tobacco products—and that's very important, because the way that tobacco is consumed is not the same anymore—in the last two or three years, we have not seen a significant slowing down in any province.

[Terence Young, Conservative, Oakville, ON]

We hadn't heard that before, I don't think; at least I don't remember hearing it.

My question is on whether it isn't disingenuous to market these products as smoking cessation when you haven't seen tobacco use go down.

[Geneviève Bois]

Well, that's why I've been saying that at the very least in the youth age group, we have not seen e-cigarettes take the place of another tobacco product. We are seeing youth experiment with various products, whether they are a small flavoured cigar, or menthol cigarettes, or flavoured e-cigarettes. But it seems to be operating as a separate kind of attempt, which might be good news for the gateway situation, but it means that now our youth are experimenting with two inhaled products. Yet, it doesn't seem to diminish the amount of appeal of the other product.

That's why we say that tobacco controls will need to be strengthened.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Mr. Collishaw, thank you for being here today. By the way, are you a doctor as well?